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ENT > Outer Ear > Flashcards

Outer Ear Flashcards

1
Q

What is the ear split up into

A

External
Middle - from TM to oval window
Inner

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2
Q

What is the pinna / auricle and what epithelium and structures make up

A

External structure of ear
Stratified keratinised epithelium
Elastic cartilage underneath

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3
Q

What does it continue as

A

Concha continues as external auditory measures

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4
Q

Is it good at sound localisation

A

No so minimal loss if obstruction

Function is to capture and transmit sound to EAM

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5
Q

What supplies the pinna

A

Mandibular branch of trigeminal (V3)

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6
Q

What supples the external auditory meatus

A

Anterior = facial

Posterior =vagus

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7
Q

What is lateral 1/3 made up of

A

Skin and cartilage
Sebaceous glands to produce wax
Thick hair
Protective barrier

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8
Q

What is medial 1/3 made up of

A

Skin and bone
No hairs or cilia
Doesn’t produce wax

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9
Q

How does skin grow in the external ear canal

A

Umbo of the tympanic membrane outwards
Shed in lateral 1/3 and trapped in wax
Why you shouldn’t remove wax

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10
Q

What are outer eat problems

A

Auricle haematoma
Foreign boy
Otitis externa
Mastoiditis

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11
Q

How do you Rx haematoma

A

Drain

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12
Q

How does foreign body present

A 
Foul discharge
Pain
Hearing loss 
Unilateral
Requires removal
Gental syringing may help
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13
Q

What is otitis externa

A

Inflammation of external ear canal
Usually unilateral
Can be acute or chronic

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14
Q

What is most common causes

A 
Bacteria = most common - 
- S.aureus / S.epidermis
- Pseudomonas with hearing aid 
Can get fungal 
- Increased risk after prolonged Ax
Seborrheic dermatitis
Contact dermatitis
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15
Q

What are the symptoms

A

Ear pain - acute on moving pinna
Itch
Discharge
Temporary conductive hearing loss

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16
Q

What is seen O/E

A

Red or white swollen EAM
May not be able to see TM due to swelling
May have lots of pus / purulent discharge
Try see TM to look for perforation which can cause 2 otitis external

17
Q

What are RF

A 
Swimming
Eczema - seborrheic / contact
Absence of wax from self cleaning 
Asthma
Allergic rhintiis
Foreign body
Immunosuppression e.g.DM
18
Q

What should you ask about / examine

A 
Fever
Tinnitus
Discharge
Examine nose + throat 
Look behind ear for swelling / scar
Lymph nodes
19
Q

What can’t you rule out

A

Otitis media / perforation as can’t see tympanic membrane

20
Q

What is treatment

A

Antibiotic ear drops + steroid = 1st line
- Gentamicin - CI if perforated TM so if can’t see don’t give
- Ciprofloxacin (unlicensed)
- Neomycin
- Have brand names
Steroid ear drop to reduce inflammation
Anti-fungal
Can give capsule if severe - fluxloaxcillnin = 1st line for oral
IV if malignant
Syringe out debris so more effective
Refer ENT if fail to respond to topical Ax
Avoid water

21
Q

What is chronic otitis externa

A

Chronic infection in EAM

Usually staph or fungal

22
Q

What are the symptoms

A

Chronic discharge
Hearing loss
Severe pain

23
Q

How do you Rx

A

Cleansing of external ear

Anti-fungal and Ax ear drops

24
Q

What is malignant otitis externa

A

Caused by spread of otitis externa into bony ear canal

25
Q

What causes

A

S.Aureus

Pseudomona’s

26
Q

What are RF

A

Immunosuppressed
Chemotherapy
Elderly
DM in 90% of cases

27
Q

What are the symptoms

A 
Failure to response to Ax 
OM temporal bone 
Persistent and foul smelling discharge
Pain out of proportion 
Ear pain 
Temporal headache
Purulent otorrhoea
Hearing loss
Fever
Dysphagia
Hoarseness
Facial nerve dysfunction
28
Q

How do you Dx

A

Refer any non resolving otitis external with worsening pain to ENT
CT scan
Can do swab for sensitivity

29
Q

How do you Rx

A

Surgical debridement
IV Ax to address OM and cover pseudomona’s
Ciprofloxacin
Gent - not used if TM perforated as ototoxic

30
Q

What is CI if malignant

A

Syringing ear

31
Q

What can referred ear pain be from

A

Mostly from teeth

32
Q

What can a pinna haematoma cause

A

Cartilage of ear starved of blood supply

Leads to cauliflower ear

33
Q

When do you give Ax

A 
Red oedematous narrow canal
Conductive hearing loss 
Discharge
Regional LN
Cellulitis behind ear
Fever
34
Q

How do you manage excessive wax

A

Topical ear drop - olive oil
Microsution
Syringe
Suction in ENT clinic

35
Q

What do you do for recurrent otitis media

A

Can insert inflation tube

ENT (14 decks)

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